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A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?
- A. Gallstones
- B. Hepatitis
- C. Pancreatic cancer
- D. Primary biliary cirrhosis
Correct Answer: C
Rationale: The most likely diagnosis for a 65-year-old man with weight loss, jaundice, palpable mass in the right upper quadrant, elevated bilirubin, and alkaline phosphatase levels is pancreatic cancer. This is because the symptoms and findings are classic for pancreatic cancer, which commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor. Weight loss is also a common symptom of pancreatic cancer. Gallstones typically present with acute episodes of biliary colic, not a palpable mass. Hepatitis typically presents with elevated liver enzymes, but not a palpable mass. Primary biliary cirrhosis presents with chronic cholestasis and autoimmune features, not a palpable mass.
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Which of the following statements is true about ischemic colitis?
- A. Typically requires colonic resection
- B. Affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum
- C. Is only seen in the elderly
- D. Requires colonoscopic intervention
Correct Answer: B
Rationale: The correct answer is B: Ischemic colitis affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum. This is because these areas have relatively poor collateral blood supply, making them more susceptible to ischemia. Ischemic colitis typically presents with abdominal pain, bloody diarrhea, and tends to affect elderly patients with cardiovascular risk factors. Choice A is incorrect as most cases of ischemic colitis can be managed conservatively without the need for colonic resection. Choice C is incorrect as ischemic colitis can occur in individuals of any age group, although it is more common in the elderly. Choice D is incorrect because colonoscopic intervention is not always necessary for the diagnosis and management of ischemic colitis.
A 35-year-old man presents with difficulty swallowing, weight loss, and regurgitation of undigested food. A barium swallow shows a 'bird beak' appearance of the lower esophagus. What is the most likely diagnosis?
- A. Esophageal cancer
- B. Achalasia
- C. Peptic stricture
- D. Gastroesophageal reflux disease
Correct Answer: B
Rationale: The correct answer is B: Achalasia. The presentation of difficulty swallowing, weight loss, regurgitation of undigested food, and 'bird beak' appearance on barium swallow are classic for achalasia. In achalasia, there is impaired relaxation of the lower esophageal sphincter and absent peristalsis in the esophagus. This leads to functional obstruction and dilation of the esophagus, causing the characteristic 'bird beak' appearance.
Incorrect Choices:
A: Esophageal cancer typically presents with progressive dysphagia, weight loss, and may show a mass or stricture on imaging.
C: Peptic stricture is usually seen in patients with long-standing gastroesophageal reflux disease or esophagitis. Symptoms are often related to acid reflux.
D: Gastroesophageal reflux disease commonly presents with heartburn, regurgitation, and chest pain. It does not typically cause weight loss or the 'bird
A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?
- A. Hepatitis B
- B. Primary biliary cirrhosis
- C. Primary sclerosing cholangitis
- D. Autoimmune hepatitis
Correct Answer: C
Rationale: The most likely diagnosis is primary sclerosing cholangitis (PSC) based on the patient's symptoms of fatigue, pruritus, jaundice, and elevated bilirubin and alkaline phosphatase levels. PSC is commonly associated with inflammatory bowel disease, such as ulcerative colitis. The characteristic findings of elevated alkaline phosphatase and bilirubin levels are indicative of cholestasis, which is a key feature of PSC. Additionally, PSC is characterized by fibrosis and inflammation of the bile ducts, leading to bile duct strictures and subsequent liver damage. Hepatitis B would present with viral hepatitis symptoms and different lab findings. Primary biliary cirrhosis typically presents with elevated alkaline phosphatase and antimitochondrial antibodies. Autoimmune hepatitis would have elevated transaminases and autoantibodies. Therefore, based on the clinical presentation and lab results, PSC is the most likely diagnosis.
A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?
- A. Nitrofurantoin (Macrodantin) orally.
- B. Erythropoietin (Epogen) intravenously.
- C. Kayexalate retention enema.
- D. Azathioprine (Imuran) orally.
Correct Answer: C
Rationale: The correct answer is C: Kayexalate retention enema. In acute renal failure with high serum potassium levels, the priority is to lower potassium levels to prevent cardiac complications. Kayexalate works by exchanging sodium ions for potassium ions in the intestines, promoting potassium excretion in the feces. This intervention helps reduce serum potassium levels quickly.
A: Nitrofurantoin is an antibiotic used to treat urinary tract infections, unrelated to managing hyperkalemia.
B: Erythropoietin is a hormone used to stimulate red blood cell production, not indicated for reducing potassium levels.
D: Azathioprine is an immunosuppressant used for various conditions like autoimmune diseases, not for managing hyperkalemia.
In summary, the correct intervention is to administer a Kayexalate retention enema to lower serum potassium levels effectively in acute renal failure. Other options are not appropriate for managing hyperkalemia.
A 35-year-old man presents with fatigue, weight loss, and hyperpigmentation of the skin. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
- A. Cushing's syndrome
- B. Addison's disease
- C. Hypothyroidism
- D. Pheochromocytoma
Correct Answer: B
Rationale: The most likely diagnosis is Addison's disease (Choice B) because the symptoms match adrenal insufficiency. The low cortisol levels indicate adrenal cortex dysfunction, leading to fatigue and weight loss. Hyponatremia and hyperkalemia result from mineralocorticoid deficiency. Hyperpigmentation occurs due to elevated ACTH levels stimulating melanin production in Addison's. Cushing's syndrome (Choice A) presents with high cortisol levels, opposite to the low levels seen here. Hypothyroidism (Choice C) does not typically cause hyponatremia or hyperkalemia. Pheochromocytoma (Choice D) manifests with hypertension and catecholamine excess, not seen in this case.